Thursday, March 02, 2006

A 'perfect storm' of events (Zogby International's poll of Iraq combat troops and a study of today's current military population appearing in the Journal of the American Medical Association) has come together to bring combat-related PTSD into the forefront this week. Both of these barometers of troop health and opinion are ground-breaking. I've already touched upon the Zogby data; here I'll take a look at what the JAMA study reveals.

Click on 'Article Link' below tags for more...

Background

A month following the start of combat operations in Iraq, the Department of Defense (DOD) implemented a post-deployment survey program of its combat veterans. Each service member was (and is still) required to complete the Post-Deployment Health Assessment (PDHA) form. At the same time, troops would also receive a face-to-face assessment by a physician, physician assistant, nurse practitioner, or independent duty corpsman/medical technician.

From the Deployment Health Clinical Center website, the purpose of the screening is to:

Positive responses require use of supplemental assessment tools and/or referrals for medical consultation. The provider will document concerns and referral needs and discuss resources available to help resolve any post-deployment issues. The original completed DD Form 2796 will be maintained in the individual's permanent medical record. A copy (paper or electronic) will be sent to the Army Medical Surveillance Activity (AMSA).

The data collected by AMSA is then integrated into the Defense Medical Surveillance System (DMSS) database – and that database is the source of data for the Hoge study.

The authors explain the reason and value for the unprecedented study (never before has population-based study been possible so immediately or fully after or even during combat ops – today's computer databases now make this possible) stating, “Such studies are an important part of measuring the mental health burden of the current war and ensuring that there are adequate resources to meet the mental health care needs of veterans returning from Iraq and Afghanistan.”

Study Participants and Window

Dr. Hoge and his colleagues used the data available from the records of 303,905 Army soldiers and Marines who’d completed a PDHA between May 1, 2003, and April 30, 2004 and had served in either Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), or other locations such as Bosnia or Kosovo. Of this population of service members, 50,611 have been detached from the military.

Study Questions and Analysis

Two questions were used to determine risk factors for depression: one examining depressed mood (“felt down, depressed, or hopeless”), the other anhedonia (“little interest or pleasure in doing things”).

Four questions were included to screen for PTSD of the key domains of PTSD (re-experiencing trauma; numbing; avoidance; and hyperarousal); an affirmative response to 2 out of the 4 questions was taken to mean the troop was considered to be at risk for PTSD. Additionally, four more questions were proffered exploring suicide, interpersonal relationships, and interest in receiving care. [See the PDHA form for more detail.]

Study Results

Not surprisingly, rates of mental health problems are higher for those deployed to OIF vs. those deployed to OEF or other locations. [One note: All statistics below are for combat soldiers and Marines. The authors explain, “Although Air Force and Navy personnel also serve in the combat environment, the majority of ground combat units are Army and Marine.”]

As already reported at PTSD Combat last month, an additional mental health screening program for our returning troops is being rolled out by the DOD: the Post-Deployment Health Reassessment (PDHRA form). Service members will participate in the health screening three-to six months after arriving home.

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.

Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

Legal Notice

The information presented on this web site is based on news reports, medical and government documents, and personal analysis. It does NOT represent therapeutic prescription or recommendation. For specific advice and information, consult your health care provider.

Comments at PTSD Combat do not necessarily represent the editor's views. Illegal or inappropriate material will be removed when brought to our attention. The existence of such does not reflect an endorsement.

This site contains at times large portions of copyrighted material not specifically authorized by the copyright owner. This material is used for educational purposes, to forward understanding of issues that concern veterans and military families. In accordance with U.S. Copyright Law Title 17 U.S.C. Section 107, the material on this site is distributed without profit. More information.